COVID-19 Vaccination in WHO’s African Region, 2021–2023: 32% Completed a Primary Series

Once COVID-19 vaccines became available in early 2021, they were an effective way to reduce illness and death. COVAX — led by Gavi, the Coalition for Epidemic Preparedness Innovations and the World Health Organization, with UNICEF — was set up to share vaccines fairly. WHO aimed to fully vaccinate 10% of the world's population by the end of 2021 and 70% by mid-2022. But low-income countries had unequal access through 2021, and the WHO African Region — 47 of Africa's 54 countries, with about 1.2 billion people — didn't get enough supply for an effective rollout until early 2022. In July 2022, WHO told countries to focus on priority groups: health care workers, older adults (50 and over) and other high-risk people.

Key findings

• By the end of 2023, 860 million doses had been delivered and 646 million given; 440 million people had received at least one dose.
• Coverage with at least one dose ranged from 0.3% (Burundi) to 89% (Mauritius).
• Among people who completed a primary series, 21% had received at least one booster.
• 46 of 47 countries were vaccinating; Eritrea never introduced COVID-19 vaccines, and Burundi focused on health workers.

Cumulative doses received and population coverage by month, WHO African Region, 2021–2023. From CDC's MMWR.

Who reached the targets

• Only four countries — Liberia, Mauritius, Rwanda and Seychelles — reached WHO's 70% primary-series target for their whole population in 2022; 29 countries stayed below 40%.
• Health workers: 11 countries passed 70% — Benin, Botswana, Comoros, Ghana, Guinea, Guinea-Bissau, Liberia, Mozambique, Rwanda, Sierra Leone and Togo.
• Older adults: only Cabo Verde and Ethiopia passed 70%, even though older people face the highest risk of severe illness and death.
• Coverage among pregnant women and people with chronic or immune-weakening conditions couldn't be estimated because of incomplete reporting.

Supply was scarce at first: Ghana and Côte d'Ivoire received the first small COVAX shipments in February and March 2021, and deliveries improved from July.

Why coverage stayed low

• Limited political commitment and logistical hurdles.
• Low perceived risk of COVID-19 and uneven vaccine confidence and demand.
• Weak health infrastructure, too few trained staff and no sustainable funding, worsened by other outbreaks, endemic diseases and economic and political instability.
• Coverage was measured against the whole population, though most countries vaccinated only people 16 or 18 and older (some from age 5) — so countries with many young people couldn't reach the targets.

What's next

WHO declared the COVID-19 global health emergency over in May 2023. In October 2023, its expert advisory group recommended a simplified single-dose primary series and updated revaccination advice for high-priority groups, and urged folding COVID-19 vaccination into primary health care and lifelong immunization, in line with Immunization Agenda 2030. The African Region's technical advisory group endorsed this in November 2023, and many countries are adding COVID-19 vaccines to routine services and multi-vaccine outreach. The authors call for community engagement to understand vaccine confidence and targeted efforts to reach high-risk groups, strengthening adult vaccination for future pandemics.

Limits: coverage relies on administrative data that may miscount doses or populations; many countries stopped reporting in 2023; fewer than half reported doses for priority groups; and population figures for those groups exist only in some countries.

Sources

Based on Doshi RH, Nsasiirwe S, Dahlke M, et al., "COVID-19 Vaccination Coverage — World Health Organization African Region, 2021–2023," Morbidity and Mortality Weekly Report 73(14), CDC; a work of the United States government in the public domain.